| NPI | 1316095938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THAD LOREN CHAMPLIN Owner President 661-945-7868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |